Ischemia but no obstructive coronary artery disease: more than meets the eye

Area of Science:

• Cardiology
• Vascular Medicine
• Women's Cardiovascular Health

Background:

• Symptomatic women with angina are disproportionately diagnosed with ischemia with no obstructive coronary arteries (INOCA) compared to men.
• INOCA is associated with significant adverse cardiovascular events, including myocardial infarction and heart failure, and negatively impacts quality of life, particularly in women.
• Despite these risks, women with INOCA are often misperceived as low-risk due to the absence of obstructive coronary artery disease.

Purpose of the Study:

• To review the prevalence, pathophysiology, clinical presentation, diagnostic approaches, and treatment strategies for INOCA.
• To highlight the unique aspects of INOCA in women, including higher symptom burden and lower quality of life.
• To emphasize the need for increased awareness and specialized management of INOCA.

Main Methods:

• This focused review synthesizes current literature on INOCA.
• Discussion includes non-invasive imaging for coronary microvascular dysfunction (CMD) and invasive coronary function testing (CFT) for coronary vasospasm.
• The review considers traditional, inflammatory, hormonal, and psychological risk factors contributing to INOCA.

Main Results:

• Coronary microvascular dysfunction (CMD) and coronary vasospasm are key pathophysiological mechanisms underlying INOCA.
• Inflammatory, hormonal, and psychological factors play a role in INOCA, alongside traditional cardiovascular risk factors.
• Current treatments involve risk factor modification and anti-anginal/anti-atherosclerotic medications, showing benefit for patient-oriented outcomes.

Conclusions:

• INOCA is a significant clinical issue, particularly for women, associated with adverse cardiovascular outcomes and reduced quality of life.
• Early diagnosis and management through specialized centers can improve patient outcomes, though robust clinical trials are needed to assess impact on major adverse cardiovascular events (MACE).
• Further research, including large randomized trials, is crucial to refine treatment strategies and improve long-term prognosis for patients with INOCA.